Healthcare Provider Details

I. General information

NPI: 1093736316
Provider Name (Legal Business Name): ACTION POTENTIAL RLLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 11/18/2020
Certification Date: 11/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2435 RESEARCH PKWY # 225
COLORADO SPRINGS CO
80920-1070
US

IV. Provider business mailing address

2035 CORTE DEL NOGAL STE 200
CARLSBAD CA
92011-1445
US

V. Phone/Fax

Practice location:
  • Phone: 719-260-8400
  • Fax: 719-235-5978
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License Number
License Number StateCO
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateCO

VIII. Authorized Official

Name: ROBERT PACE
Title or Position: OWNER
Credential:
Phone: 213-804-1712